Pain Management

Migraine Headaches

06/12/2007

Question:

I am a 45 year old female who has had migraines for many years, but my migraine headaches are more intense and come on suddenly, with lots of pressure on right side. I had an MRI which revealed few punctuate foci of signal abnormality within the right frontal sub-cortical white matter. That is the site of pain. Should I be concerned?

Answer:

White matter abnormal signal, on MRI, is common in migraine patients and in the majority is not concerning. However, it is usually symmetric and bilateral. In your case, it is only on the right. Still it is probably not concerning and is migraine related. Having said that, I recommend an evaluation with carotid duplex to exclude right carotid artery blockage that can ne responsible for the abnormal right white matter lesion in your case. I also advise risk factor control such as cessation of smoking, exercise, weight loss, hydration, low fat diet, and sleep hygiene. More importantly, I recommend an evaluation by a neurologist who needs to look at the whole clinical picture (your migraine headache, risk factors for white matter disease, and the MRI films).

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